中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (17): 3226-3230.doi: 10.3969/j.issn.1673-8225.2010.17.047

• 骨与关节临床实践 clinical practice of the bone and joint • 上一篇    

椎间融合器植入并双侧下关节突切除治疗退变性腰椎管狭窄症

曹俊明，张  迪，申  勇，张英泽，丁文元，杨大龙，徐佳欣   

  1. 河北医科大学第三医院脊柱外科，河北省石家庄市  050051
  • 出版日期:2010-04-23 发布日期:2010-04-23
  • 通讯作者: 申 勇，教授，主任医师，博士生导师，河北医科大学第三医院脊柱外科，河北省石家庄市 050051
  • 作者简介:曹俊明☆，男，1981年生，汉族，山西省孝义市人，河北医科大学在读博士，主要从事脊柱外科研究。

Interbody fusion cage implantation and bilateral inferior articular process resection for the treatment of degenerative lumbar spinal stenosis

Cao Jun-ming, Zhang Di, Shen Yong, Zhang Ying-ze, Ding Wen-yuan, Yang Da-long, Xu Jia-xin   

  1. Department of Spinal Surgery, Third Hospital of Hebei Medical University, Shijiazhuang   050051, Hebei Province, China
  • Online:2010-04-23 Published:2010-04-23
  • Contact: Shen Yong, Professor, Chief physician, Doctor's supervisor, Department of Spinal Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei Province, China
  • About author:Cao Jun-ming☆, Studying for doctorate, Department of Spinal Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei Province, China caojunming2001@126.com

PDF

391

被引次数

8

摘要：

背景：对退变性腰椎管狭窄治疗可行全椎板减压内固定置入、单侧或双侧开窗减压、后路全椎板减压等方法。但采取何种方式治疗中是否需行椎间融合器植入内固定目前还没有定论。
目的：评价以cage椎间植骨融合椎弓根内植入固定并腰后路全椎板及双侧下关节突切除减压、自体小关节骨质移植治疗退变性腰椎管狭窄症的效果。
方法：选择经3个月保守治疗无效的退变性腰椎管狭窄症患者41例，男23例，女18例，平均年龄60.3岁，行腰后路全椎板及双侧下关节突切除减压、自体小关节骨质及cage椎间植骨融合植入椎弓根内固定治疗，随访24个月，术前及术后随访时JOA评分评价患者疗效，放射学检查患者植骨融合情况及手术节段椎体稳定性。
结果与结论：随访时JOA评分较术前有明显提高(P < 0.01)，临床优良率为90%；40例获得骨性融合，融合率98%，1例患者有腰椎不稳征象。术后均无内固定物松动、断裂等并发症发生，但有2例发生硬脊膜撕裂，1例发生椎弓根位置偏斜，1例假关节形成。结果提示腰后路全椎板及双侧下关节突切除减压、自体小关节骨质及cage椎间植骨融合植入椎弓根内固定治疗退变性腰椎管狭窄症具有良好的临床效果。

关键词: 腰椎管狭窄症, 退变, 椎间融合, 小关节, 医学植入体

Abstract:

BACKGROUND: Degenerative lumbar spinal stenosis could be treated by laminectomy internal fixation placement, unilateral or bilateral decompression, posterior laminectomy and so on. However, whether laminectomy internal fixation placement can be used remains unclear.
OBJECTIVE: To evaluate the efficacy of interbody fusion cage implantation of pedicle screw fixation, in combination with posterior lumbar laminectomy, bilateral resection and decompression of the inferior articular process, autologous facet joint bone transplantation in the treatment of degenerative lumbar spinal stenosis.
METHODS: A total of 41 patients of degenerative lumbar spinal stenosis, who failed after 3 months of conservative therapy, including 23 males and 18 females, at a mean of 60.3 years, received posterior lumbar laminectomy, bilateral inferior articular process resection and decompression, autologous facet joint bone and cage interbody fusion implant pedicle fixation. They were followed up for 24 months, preoperative and postoperative Japanese Orthopedic Association (JOA) score evaluations were performed to assess the therapeutic efficacy of the patients, radiological examination was done to investigate the graft fusion and vertebral stability of surgical segments in patients.
RESULTS AND CONCLUSION: During the follow-up, JOA score significantly increased compared with the preoperative score  (P < 0.01) and clinical excellence rate was 90%; 40 cases obtained bony fusion, with a fusion rate of 98%, 1 patient exhibited signs of lumbar instability. There was no loosening, fracture and other complications after internal fixation, but 2 cases appeared dural tear, 1 case pedicle position deviation, 1 case pseudoarticulation formation. The results suggest that the posterior lumbar laminectomy, bilateral inferior articular process resection and decompression, autogenous facet joint bone and cage interbody fusion implanted pedicle screw fixation show good clinical effects for the treatment of degenerative lumbar spinal stenosis.

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